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Parathyroid Localization and Imaging

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Endocrine Surgery

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

For many years bilateral cervical exploration with identification of four glands remained the gold standard in parathyroid surgery, and routine preoperative imaging for initial surgery was considered unnecessary and not cost effective. In 1986, John L. Doppman stated “In my opinion, the only localizing study indicated in a patient with untreated primary hyperparathyroidism (HPT) is to localize an experienced parathyroid surgeon” [1]. Times have changed, and undoubtedly it is the progress of imaging studies that has modified the surgical management of patients with HPT and helped the development of new surgical techniques.

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References

  1. Doppman JL. Reoperative parathyroid surgery; localization procedures. Prog Surg 1986;18:117–32

    Google Scholar 

  2. Lumachi F, Ermani M, Basso S, et al. Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection. Endocr Relat Cancer 2001;8(1):63–9.

    Article  Google Scholar 

  3. Dijkstra B, Healy C, Kelly LM, et al. Parathyroid localisation–current practice. J R Coll Surg Edinb 2002;47(4):599–607.

    Google Scholar 

  4. Takami H, Oshima M, Sugawara I, et al. Pre-operative localization and tissue uptake study in parathyroid imaging with technetium-99m-sestamibi. Aust N Z J Surg 1999;69(9):629–31.

    Article  Google Scholar 

  5. Stark DD, Gooding GA, Moss AA, et al. Parathyroid imaging: comparison of high-resolution CT and high-resolution sonography. AJR Am J Roentgenol 1983;141(4):633–8.

    Google Scholar 

  6. Tziakouri C, Eracleous E, Skannavis S, et al. Value of ultrasonography, CT and MR imaging in the diagnosis of primary hyperparathyroidism. Acta Radiol 1996;37(5):720–6.

    Article  Google Scholar 

  7. Doppman JL, Miller DL. Localization of parathyroid tumors in patients with asymptomatic hyperparathyroidism and no previous surgery. J Bone Miner Res 1991;6 Suppl 2:S153–8; discussion S9.

    PubMed  Google Scholar 

  8. Miller DL, Doppman JL, Shawker TH, et al. Localization of parathyroid adenomas in patients who have undergone surgery. Part I. Noninvasive imaging methods. Radiology 1987;162(1 Pt 1):133–7.

    PubMed  CAS  Google Scholar 

  9. Charboneau JW, Grant CS, James EM, et al. High-resolution ultrasound-guided percutaneous needle biopsy and intraoperative ultrasonography of a cervical parathyroid adenoma in a patient with persistent hyperparathyroidism. Mayo Clin Proc 1983;58(8):497–500.

    Google Scholar 

  10. Sacks BA, Pallotta JA, Cole A, et al. Diagnosis of parathyroid adenomas: efficacy of measuring parathormone levels in needle aspirates of cervical masses. AJR Am J Roentgenol 1994;163(5):1223–6.

    Google Scholar 

  11. Tikkakoski T, Stenfors LE, Typpo T, et al. Parathyroid adenomas: pre-operative localization with ultrasound combined with fine-needle biopsy. J Laryngol Otol 1993;107(6):543–5.

    Article  Google Scholar 

  12. Grant CS, van Heerden JA, Charboneau JW, et al. Clinical management of persistent and/or recurrent primary hyperparathyroidism. World J Surg 1986;10(4):555–65.

    Google Scholar 

  13. Rodriquez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg 1994;129(8):870–5.

    Google Scholar 

  14. Kim C. K. HRS. Sestamibi scintigraphy and ultrasonography in primary hyperparathyroidism. In: Schwartz A. E. PD, Gagner M., ed. Endocrine surgery. New York: Dekker M.:231–42.

    Google Scholar 

  15. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med 2005;35(4):266–76.

    Article  Google Scholar 

  16. Nguyen BD. Parathyroid imaging with Tc-99m sestamibi planar and SPECT scintigraphy. Radiographics 1999;19(3):3–14; discussion 15–6.

    Google Scholar 

  17. Coakley AJ, Kettle AG, Wells CP, et al. 99Tcm sestamibi–a new agent for parathyroid imaging. Nucl Med Commun 1989;10(11):791–4.

    Article  Google Scholar 

  18. Taillefer R, Boucher Y, Potvin C, et al. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med 1992;33(10):1801–7.

    Google Scholar 

  19. Moka D, Eschner W, Voth E, et al. Iterative reconstruction: an improvement of technetium-99m MIBI SPET for the detection of parathyroid adenomas? Eur J Nucl Med 2000;27(5):485–9.

    Article  Google Scholar 

  20. Hindie E, Melliere D, Jeanguillaume C, et al. Parathyroid imaging using simultaneous double-window recording of technetium-99m-sestamibi and iodine-123. J Nucl Med 1998;39(6):1100–5.

    Google Scholar 

  21. Neumann DR, Esselstyn CB, Jr., Go RT, et al. Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol 1997;169(6):1671–4.

    Google Scholar 

  22. Leslie WD, Dupont JO, Bybel B, et al. Parathyroid 99mTc-sestamibi scintigraphy: dual-tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging 2002;29(12):1566–70.

    Article  Google Scholar 

  23. Hindie E, Melliere D, Simon D, et al. Primary hyperparathyroidism: is technetium 99m-Sestamibi/iodine-123 subtraction scanning the best procedure to locate enlarged glands before surgery? J Clin Endocrinol Metab 1995;80(1):302–7.

    Article  Google Scholar 

  24. Chen CC, Holder LE, Scovill WA, et al. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m-sestamibi and technetium-99m-sestamibi SPECT. J Nucl Med 1997;38(6):834–9.

    Google Scholar 

  25. Billotey C, Sarfati E, Aurengo A, et al. Advantages of SPECT in technetium-99m-sestamibi parathyroid scintigraphy. J Nucl Med 1996;37(11):1773–8.

    Google Scholar 

  26. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128(1):29–35.

    Article  Google Scholar 

  27. Civelek AC, Ozalp E, Donovan P, et al. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surgery 2002;131(2):149–57.

    Article  Google Scholar 

  28. Lorberboym M, Minski I, Macadziob S, et al. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003;44(6):904–8.

    Google Scholar 

  29. Gayed IW, Kim EE, Broussard WF, et al. The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med 2005;46(2):2–52.

    Google Scholar 

  30. Taieb D, Hassad R, Sebag F, et al. Tomoscintigraphy improves the determination of the embryologic origin of parathyroid adenomas, especially in apparently inferior glands: imaging features and surgical implications. J Nucl Med Technol 2007;35(3):135–9.

    Article  Google Scholar 

  31. Kim CK, Kim S, Krynyckyi BR, et al. The efficacy of sestamibi parathyroid scintigraphy for directing surgical approaches based on modified interpretation criteria. Clin Nucl Med 2002;27(4):246–8.

    Article  Google Scholar 

  32. Sebag F, Hubbard JG, Maweja S, et al. Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism. Surgery 2003;134(6):1038–41; discussion 41–2.

    Google Scholar 

  33. Rubello D, Massaro A, Cittadin S, et al. Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery. Eur J Nucl Med Mol Imaging 2006;33(9):1091–4.

    Article  Google Scholar 

  34. Kohri K, Ishikawa Y, Kodama M, et al. Comparison of imaging methods for localization of parathyroid tumors. Am J Surg 1992;164(2):140–5.

    Article  Google Scholar 

  35. Shen W, Duren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 1996;131(8):861–7; discussion 7–9.

    Google Scholar 

  36. Jaskowiak N, Norton JA, Alexander HR, et al. A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg 1996;224(3):308–20; discussion 20–1.

    Article  Google Scholar 

  37. Kebebew E, Arici C, Duh QY, et al. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg 2001;136(8):878–85.

    Google Scholar 

  38. Krubsack AJ, Wilson SD, Lawson TL, et al. Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors. Surgery 1989;106(4):639–44; discussion 44–6.

    Google Scholar 

  39. Peeler BB, Martin WH, Sandler MP, et al. Sestamibi parathyroid scanning and preoperative localization studies for patients with recurrent/persistent hyperparathyroidism or significant comorbid conditions: development of an optimal localization strategy. Am Surg 1997;63(1):37–46.

    Google Scholar 

  40. Thompson GB, Grant CS, Perrier ND, et al. Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. Arch Surg 1999;134(7):699–704; discussion –5.

    Google Scholar 

  41. De Feo ML, Colagrande S, Biagini C, et al. Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214(2):393–402.

    Google Scholar 

  42. Auffermann W, Gooding GA, Okerlund MD, et al. Diagnosis of recurrent hyperparathyroidism: comparison of MR imaging and other imaging techniques. AJR Am J Roentgenol 1988;150(5):1027–33.

    Google Scholar 

  43. Doherty GM, Doppman JL, Miller DL, et al. Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Ann Surg 1992;215(2):101–6.

    Article  Google Scholar 

  44. Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 1998;383(2):174–9.

    Google Scholar 

  45. Rodgers SE, Hunter GJ, Hamberg LM, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 2006;140(6):6–40; discussion 40–1.

    Article  Google Scholar 

  46. Levin KE, Gooding GA, Okerlund M, et al. Localizing studies in patients with persistent or recurrent hyperparathyroidism. Surgery 1987;102(6):917–25.

    Google Scholar 

  47. Erdman WA, Breslau NA, Weinreb JC, et al. Noninvasive localization of parathyroid adenomas: a comparison of X-ray computerized tomography, ultrasound, scintigraphy and MRI. Magn Reson Imaging 1989;7(2):187–94.

    Article  Google Scholar 

  48. Numerow LM, Morita ET, Clark OH, et al. Persistent/recurrent hyperparathyroidism: a comparison of sestamibi scintigraphy, MRI, and ultrasonography. J Magn Reson Imaging 1995;5(6):702–8.

    Article  Google Scholar 

  49. Fayet P, Hoeffel C, Fulla Y, et al. Technetium-99m sestamibi scintigraphy, magnetic resonance imaging and venous blood sampling in persistent and recurrent hyperparathyroidism. Br J Radiol 1997;70(833):459–64.

    Google Scholar 

  50. Gotway MB, Reddy GP, Webb WR, et al. Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 2001;218(3):783–90.

    Google Scholar 

  51. Neumann DR, Esselstyn CB, Maclntyre WJ, et al. Comparison of FDG-PET and sestamibi-SPECT in primary hyperparathyroidism. J Nucl Med 1996;37(11):1809–15.

    Google Scholar 

  52. Cook GJ, Wong JC, Smellie WJ, et al. [11C]Methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism after surgery. Eur J Endocrinol 1998;139(2):195–7.

    Article  Google Scholar 

  53. Lange-Nolde A, Zajic T, Slawik M, et al. PET with 18F-DOPA in the imaging of parathyroid adenoma in patients with primary hyperparathyroidism. A pilot study. Nuklearmedizin 2006;45(5):193–6.

    Google Scholar 

  54. Miller DL. Endocrine angiography and venous sampling. Radiol Clin North Am 1993;31(5):1051–67.

    Google Scholar 

  55. Miller DL. Arteriography and venous sampling for the localization of endocrine tumors. In: Taveras JM FJ, ed. Radiology Diagnosis-Imaging-Intervention. Philadelphia: Lippincott-Raven;1996:1–10.

    Google Scholar 

  56. Doppman JL. Parathyroid localization: arteriography and venous sampling. Radiol Clin North Am 1976;14(2):163–88.

    Google Scholar 

  57. Sugg SL, Fraker DL, Alexander R, et al. Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism. Surgery 1993;114(6):1004–9; discussion 9–10.

    Google Scholar 

  58. Rotstein L, Irish J, Gullane P, et al. Reoperative parathyroidectomy in the era of localization technology. Head Neck 1998;20(6):535–9.

    Article  Google Scholar 

  59. Chaffanjon PC, Voirin D, Vasdev A, et al. Selective venous sampling in recurrent and persistent hyperparathyroidism: indication, technique, and results. World J Surg 2004;28(10):958–61.

    Article  Google Scholar 

  60. Miller DL. Pre-operative localization and interventional treatment of parathyroid tumors: when and how? World J Surg 1991;15(6):706–15.

    Article  Google Scholar 

  61. Miller DL, Chang R, Doppman JL, Norton JA. Localization of parathyroid adenomas: superselective arterial DSA versus superselective conventional angiography. Radiology 1989;170(3 Pt 2):1003–6.

    PubMed  CAS  Google Scholar 

  62. McIntyre RC, Jr., Kumpe DA, Liechty RD. Reexploration and angiographic ablation for hyperparathyroidism. Arch Surg 1994;129(5):5–503; discussion 4–5.

    Google Scholar 

  63. MacFarlane MP, Fraker DL, Shawker TH, et al. Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. Surgery 1994;116(6):959–64; discussion 64–5.

    Google Scholar 

  64. Harman CR, Grant CS, Hay ID, et al. Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery 1998;124(6):1011–9; discussion 9–20.

    Article  Google Scholar 

  65. Dudley NE. Methylene blue for rapid identification of the parathyroids. Br Med J 1971;3(5776):680–1.

    Article  Google Scholar 

  66. Kern KA, Shawker TH, Doppman JL, et al. The use of high-resolution ultrasound to locate parathyroid tumors during reoperations for primary hyperparathyroidism. World J Surg 1987;11(5):579–85.

    Article  Google Scholar 

  67. Norman JG, Jaffray CE, Chheda H. The false-positive parathyroid sestamibi: a real or perceived problem and a case for radioguided parathyroidectomy. Ann Surg 2000;231(1):31–7.

    Article  Google Scholar 

  68. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg 1998;64(5):391–5; discussion 5–6.

    Google Scholar 

  69. Goldstein RE, Blevins L, Delbeke D, et al. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg 2000;231(5):732–42.

    Article  Google Scholar 

  70. Inabnet WB, 3rd, Kim CK, Haber RS, Lopchinsky RA. Radioguidance is not necessary during parathyroidectomy. Arch Surg 2002;137(8):967–70.

    Google Scholar 

  71. van Heerden JA, Grant CS. Surgical treatment of primary hyperparathyroidism: an institutional perspective. World J Surg 1991;15(6):688–92.

    Article  Google Scholar 

  72. Wei JP, Burke GJ. Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99m sestamibi scan. Am J Surg 1995;170(5):488–91.

    Article  Google Scholar 

  73. Casas AT, Burke GJ, Mansberger AR, Jr., et al. Impact of technetium-99m-sestamibi localization on operative time and success of operations for primary hyperparathyroidism. Am Surg 1994;60(1):12–6; discussion 6–7.

    Google Scholar 

  74. Ryan JA, Jr., Eisenberg B, Pado KM, et al. Efficacy of selective unilateral exploration in hyperparathyroidism based on localization tests. Arch Surg 1997;132(8):886–90; discussion 90–1.

    Google Scholar 

  75. Schell SR, Dudley NE. Clinical outcomes and fiscal consequences of bilateral neck exploration for primary idiopathic hyperparathyroidism without preoperative radionuclide imaging or minimally invasive techniques. Surgery 2003;133(1):32–9.

    Article  Google Scholar 

  76. Takagi H, Tominaga Y, Uchida K, et al. Comparison of imaging methods for diagnosing enlarged parathyroid glands in chronic renal failure. J Comput Assist Tomogr 1985;9(4):733–7.

    Article  Google Scholar 

  77. Clark OH, Stark DA, Duh QY, Arnaud CD, et al. Value of high resolution real-time ultrasonography in secondary hyperparathyroidism. Am J Surg 1985;150(1):9–17.

    Article  Google Scholar 

  78. Torregrosa JV, Fernandez-Cruz L, Canalejo A, et al. (99m)Tc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg 2000;24(11):1386–90.

    Article  Google Scholar 

  79. Henry JF, Sebag F, Tamagnini P, et al. Endoscopic parathyroid surgery: results of 365 consecutive procedures. World J Surg 2004;28(12):1219–23.

    Article  Google Scholar 

  80. Henry JF, Sebag F., Cherenko M., et al. Endoscopic parathyroidectomy: Why and when? World J Surg 2008;32(12):2509–15.

    Google Scholar 

  81. Edis AJ, Sheedy PF, Beahrs OH, et al. Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies. Surgery 1978;84(3):384–93.

    Google Scholar 

  82. Thompson NW, Eckhauser FE, Harness JK. The anatomy of primary hyperparathyroidism. Surgery 1982;92(5):5814–21.

    Google Scholar 

  83. Wang CA. Parathyroid re-exploration. A clinical and pathological study of 112 cases. Ann Surg 1977;186(2):140–5.

    Article  Google Scholar 

  84. Carty SE, Norton JA. Management of patients with persistent or recurrent primary hyperparathyroidism. World J Surg 1991;15(6):716–23.

    Article  Google Scholar 

  85. Wadstrom C, Zedenius J, Guinea A, et al. Re-operative surgery for recurrent or persistent primary hyperparathyroidism. Aust N Z J Surg 1998;68(2):103–7.

    Article  Google Scholar 

  86. Schlinkert RT, Whitaker MD, Argueta R. Resection of select mediastinal parathyroid adenomas through an anterior mediastinotomy. Mayo Clin Proc 1991;66(11):1110–3.

    Google Scholar 

  87. Prinz RA, Lonchyna V, Carnaille B, et al. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 1994;116(6):999–1004; discussion -5.

    Google Scholar 

  88. Casanova D, Sarfati E, De Francisco A, et al. Secondary hyperparathyroidism: diagnosis of site of recurrence. World J Surg 1991;15(4):546–9; discussion 9–50.

    Article  Google Scholar 

  89. Nordenstrom E, Westerdahl J, Isaksson A, et al. Patients with elevated serum parathyroid hormone levels after parathyroidectomy: showing signs of decreased peripheral parathyroid hormone sensitivity. World J Surg 2003;27(2):212–5.

    Google Scholar 

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Authors and Affiliations

  1. Department of General and Endocrine Surgery, University Hospital La Timone, Query, Marseille, France

    Jean-François Henry MD

  2. Department of Nuclear Medicine, Service Central de Biophysique et de Médecine Nucléaire, Centre hospitalo-universitaire de la Timone, Query, Marseille, France

    David Taïeb MD

  3. Department of Endocrine Surgery, Service de Chirurgie Endocrinienne, Centre hospitalo-universitaire de la Timone, Query, Marseille, France

    Sam Van Slycke MD

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  1. Jean-François Henry MD
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Editors and Affiliations

  1. St Thomas Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom

    Johnathan Hubbard

  2. Coll Physicians & Surgeons Columbia, Fort Washington Avenue 161, New York, 10032, U.S.A.

    William B. Inabnet

  3. Queen Mary Hospital, University of Hong Kong Medical Centre, Pokfulam, Hong Kong, China, People's Republic

    Chung-Yau Lo

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Henry, JF., Taïeb, D., Van Slycke, S. (2009). Parathyroid Localization and Imaging. In: Hubbard, J., Inabnet, W., Lo, CY. (eds) Endocrine Surgery. Springer Specialist Surgery Series. Springer, London. https://doi.org/10.1007/978-1-84628-881-4_17

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